The introduction of peripheral stem cell (PSC) and cord blood (CB) as an alternative to bone marrow (BM) recently has caused important changes on hematopoietic stem cell transplantation (HSCT) practice. According to the CIBMTR data, there has been a significant decrease in the use of bone marrow and increase in the use of PSC and CB as the stem cell source for HSCT performed during 1997–2006 period for patients under the age of 20. On the other hand, the stem cell source in 70% of the HSCT procedures performed for patients over the age of 20 was PSC and the second most preferred stem cell source was bone marrow. CB usage is very limited for the adult population. Primary disease, stage, age, time and urgency of transplantation, HLA match between the patient and the donor, stem cell quantity, and the experience of the transplantation center are some of the associated factors for the selection of the appropriate stem cell source. Unfortunately, there is no prospective randomized study aimed to facilitate the selection of the correct source between CB, PSC, and BM. In this paper, we would like to emphasize the data on stem cell selection in light of the current knowledge for patient populations according to their age and primary disease. 1. Trials Comparing Bone Marrow and Peripheral Stem Cell One of the main reasons for preferring PSC worldwide is the important advantages provided by this method to the donor. These advantages are avoidance of anesthesia, lack of the need for hospitalization or blood transfusion, and very low serious adverse event risk. The largest trial to date comparing these different stem cell sources in HLA matched sibling donor setting was the meta-analysis of IBMTR/EBMT including 536 and 288 patients, who received BM and PSC, respectively [1]. In this trial, a faster neutrophil and platelet engraftment were observed in PSC arm. However, there was no statistically significant difference for relapse and grade II–IV acute graft-versus-host disease (aGvHD) between groups. After 1 year of followup, chronic GVHD frequency was significantly higher in the PSC (65%) arm compared to BM (53%) arm. Between 1998 and 2002, BM and PSC as a stem cell source were compared in 8 randomized trials [2–9]. Almost all of the patients included were diagnosed as leukemia. Number of patients included, remission status, conditioning regimen, GvHD prophylaxis, stem cell, and T-cell numbers were significantly different in these studies. Combined results suggest faster neutrophil and platelet engraftment with PSC compared to BM. One of the trials revealed similar
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